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POLICY OF INsuRANcE
IJB
JF OPTIMUM \(ISITOR
E恫 ECTM! JANUAJl.Y2灿 15
IN THE EVENT OF AN EMERGENCY OR HOSPITALIZATION, YOU MUST CALL
THE ASSISTANCE COMPANY IMMEDIATELY:
From Canada and U.S. , call toll fTee 1-866-209-5804 From anywhere , call collect 905-707-9555
Do not assume that someone will contact the assistance company on your behal f. It remains your responsibility
to ensure that the assistance company has been contacted prior to receiving treatment or as soon as reasonably possible
1. Throughout this policy, words in italics have a specific meaning and are defined in SECTION 11DEFINITIONS.
2. This insurance is designed to CQver losses arising from sudden and unforeseeable circumstances.
It is important that you read and understand your policy, as your coverage may be subject to
certain limitations and exclusions.
3. Apre-e.λ isting medical condition exclusion may apply to medical conditions and/or symptoms that
existed prior to your trip. Check to see how this applies in your policy and how it re1 ates to your
effective date.
·S 盟iitlJ@11
Defini tions
Accident means a fortuitous, sudden, unforeseen and unintentional event exclusively attributable to
an extemal cause resulting in i叼 ury.
Act(s) ofterrorism means an act , including but not limited to the use offorce or violence and/or the
threat thereof or commission or threat of a dangerous act , of any person or group(s) or government(纱 ， committed for political , religious , ideological , social , economic or similar pu甲 oses including the intention to intimidate , coerce or overthrow a government (whether de f邵阳 or de jure) or to
influence, affect or protest against any govemment and/or to put the civilian population, or any section ofthe civilian population , in fear.
Act(s) ofwar means any loss or damage arising directly or indirectly from , occasioned by, happen
ing through or in consequence ofwar, invasion , acts offoreign enemies , hostilities or warlike opera
tions (whether war is declared or not) by any govemment or sovereign , using military personnel or
other agents , civil war, rebe l1 ion , revolution , insuπection ， civil commotion assuming the proportions
of or amounting to an uprising , milita叩 or usurped power.
Administrator Company means JF Tnsurance Agency Group Tnc. appointed by the insurer in administering this JF Optimum Visitor insurance policy
Application Date means the date that the application is received at the ins町町 's head office or the
office of an authori zed agen t. Coverage will not be effective until the insurer has approved the application and received the appropriate premium
Assistance Company means OnTime Care Worldwide Tnc. , a division of JF Tnsurance Agency
Group Tnc ., and SelectCare Worldwide Tnc., which are responsible for providing travel assistance ,
case management and claims assistance se凹 lces.
Child(ren) means your or your spouse's unmarried child (including step-child, adopted child, or a
child of whom you have been granted custody pursuant to an Order of the Court) who is chiefly de
pendent on you or yo町 spouse for support and maintenance , and who is
a. over fifteen (1 5) days of age and under twenty-two (22) years of age on the date ofpurchase
of this policy; or
b. a child of any age over fifteen (15) days who has a permanent physical impairment or a
permanent mental deficiency on the date of purchase
Country ofOrigin means the country for which you hold a passpo口 Where you hold more than one
passpo此， the country of origin will be taken to mean the country that you have declared on the application. Where a famiJy is to be covered by the policy, there will be deemed to be one country of
origin for the famiJy , which will be the country of origin declared on the application
Deductible means the amount (if applicable) in Canadian dollars , which you must pay before any
remaining eligible expenses are reimbursed under this policy. The deductible applies once per insured person , per covered trip
Departure Date means the day you leave your country of origin , or departure poin t.
Departure Point means the province , territory or country you depart 仕om on the first day ofyourin
tended travel period
Effective date means your insurance policy commences on the latest of:
a. your appJication date;
b. 12 :01 a.m. (I ocal time) on the effective date as shown on your application or confirmation of
msurance; or
c. the specific time and date of your arrival in Canada. Proof of your date of arrival may be
required
Exception: When you purchase this policy prior to leaving your country of origin and provided
you have paid the appropriate premium , coverage will commence on the date of departure from
yourcount厅。 forigin (date indicated on your plane ticket) for your uninterrupted trip to Canada
Emergency means that you require immediate medicaJ treatment for the relief of acute pain or suffering resulting from an unexpected and unforeseen sickness or i呵jury occurring while on a covered
trip and that such medicaJ treatment cannot be delayed until your retum to your country of origin
Expiry Date means coverage under this plan terminates on the earliest of:
a. 门 : 59 p.m. (I ocal time) on the expiry date indicated on the application or policy confirmation;
b . 门 : 59 p.m. (I ocal time) on the date calculated by the insurer, due to an incorrect premium
payment;
c. the date you become eligible 白or a government pJan in Canada; or
d. the date and time you leave Canada (except when leaving for an eligible temporary trip please refer to Section V - C - Duration ofCoverage)。
Fa皿i1y means you an d/or yo町 spouse and yo町 chiJd(ren) when your names appear on the applica
tion or confirmation of insurance. Coverage dates are the same for all family members. AII family
members must live at the same address while in Canada
Govemment Plan means any plan of insurance provided by or under the administrative control of
any govemment or agency in accordance with any law (other than the Employment Insurance Act of
Canada) or any plan providing insurance coverage regulated by any govemment
Hospital means an institution which is designated as a hospital by law; which is continuously
staffed by one or more physicians at all tim口; which continuously provides nursing se凹ices by
graduate registered nurses; which is primarily engaged in providing diagnostic services an d/or medical and surgical treatment of a sickness or injury in the acute phase , or active treatment of a chronic
sickness; which has facilities for diagnos阻， m句 or surgery and in-patient care. The term hospital
does not include convalescent, nursing , rest or skilled n盯sing faciliti口， whether separate from or
part of a regular general hospital , nor a 臼cility operated exclusively for the treatment ofpersons who
are mentally ill , aged , drug or alcohol abusers
Hospitalization or Hospitalized means an insured who occupies a hospi臼J bed for more than 24
hours for medicaJ treatment and for which admission was recommended by a physician when medicaJJy necessary.
JFOPT 2015-01
4. In the event of an accident, injury or sickness , your prior medical history will be reviewed
after a claim has been repo口ed
5. All amounts are in Canadian currency, unless indicated otherwise
6. Your policy provides assistance for medical emergencies. If you experience a medical
emergency, you must notify our assistance company prior to treatment or within 24 hours of
receiving emergency medicaJ trea的lent or being admitted to hospitaJ. Your policy may limit
benefits should you not contact the assistance company
7. This policy is underwritten by CUMIS General Insurance Company, a member ofThe
Co-operators group of companies
Please read this policy carefully.
Immediate Family Member means your mother, father, sibling , chiJd, spouse, grandparent ,
grandchild , aunt , uncle , niece , nephew, mother-in-Iaw, father-in-Iaw, son-in-Iaw, daugh
ter-in-Iaw, brother-in-Iaw or sister-in-Iaw
Injury means an unexpected and unforeseen harm to the body caused by an accider时， occurnng
while on a covered trip and which requires immediate emergency treatment that is covered by
this policy
Insured or Insured Person means the eligible person(s) named in the application attached to and
forming part ofthe policy, who have paid the required premiums for the covered period stated in
the application and meets all ofthe conditions ofthe policy
Insurer means means CUMIS General Insurance Company, a member of The Co-operators
group of companies
Medical Treatment means any reasonable procedure which is medical , therapeutic or diagnostic
in nature , which is medicaJJy necess盯y and which is prescribed by a physician. Medical treat
ment includes hospitalization , basic investigative testing, surgery, prescription medication (in
c1 uding prescribed as needed) or other treatment directly related to the sickness, injury or symp
tom
Medically Necessary in reference to a given se凹 ice or supply means such service or supply:
a. is appropriate and consistent with the diagnosis according to accepted community
standards of medical practice;
b. is not experimental or investigative in nature;
c. cannot be omitted without adversely a仔ecting your condition or quality of medical care;
and
d. cannot be delayed until your retum to your country of origin
Period of Coverage means the number of days of coverage for which a premium has been paid
and for the dates indicated on your application
Physician means a medical practitioner whose legal and professional standing within hislher jurisdiction is equivalent to that ofa doctor ofmedicine (M.D .) licensed in Canada, who is duly licensed in the jurisdiction in which he/she practices , who prescribes drugs and/or performs surgery and who gives medical care within the scope ofhis/her licensed authority. A physician must
be a person other than yourseJf or an immediate 血miJy member.
Pre-Existing Medical Condition(s) means any medical condition , sickness or i吨jury for which
at any time prior to the effective date, you have experienced symptoms, you have received medi
cal care , advice , investigation or medicaJ treatment, you have been hospitaJized, you have been
prescribed (including prescribed as needed) or have taken medication , or you have undergone a
medical surgical procedure.
Professional Sport means an activity that allows you to earn the m句 ority of your income by engaging in such activity
Reasonable and Customary Costs means costs that are incurred for approved , eligible medical
se凹ices or supplies and that do not exceed the standard fee of other providers of similar standing
in the same geographical area , for the same treatment of a similar sickness or 均 ury
Retum Date means the date on which you are scheduled to retum to your departure point, as
shown on your application.
Sickness means a disease or disorder of the body which results in loss while this coverage is in
effec t. The sickness must be sufficiently serious to prompt a reasonably prudent person to con
sult a physician for the purpose of 1l>edicaJ treatmen t.
Spouse means the person to whom you are legally married or with whom you have been residing
for at least the last 12 months
Stable means
1. An y medical condition which is under treatment and has been controlled by diet or consistent
use ofmedication prescribed by a physician for which in the one hundred twenty (120) days
prior to the effective date
a. there have been no new symptoms , more frequent or more severe symptoms;
b. there has been no change in treatment(a reduction or elimination oftreatmentresulting
from an improved health condition , approved by a physician , does not consti 阳te a
change in treatment);
c. there has been no change in medication or dosage (a reduction in dosage or an
elimination of medication resulting from an improved health condition , approved by a
physician , does not constitute a change in medication or dosage);
d. there has been no deterioration of your medical condition;
e. there has been no hospitalization or referrals to a specialist including initial follow-up
visits , tests or investigations booked in conjunction with a medical condition or
symptom;
f. there is no further testing , treatment or investigation booked or results pending;
g. you have not experienced a symptom that remains undiagnosed;
h. and for which no further medicaJ trea臼lent after departure would be anti日 pated
2. A medical condition that existed more than 120 days prior to the effective date and which did
not require treatment, as determined by a physician , during the 120 days prior to the effective
date of this policy
Sum Insured means the maximum sum payable (either $10 ,000 , $15 ,000 , $25 ,000 , $50 ,000 ,
$100 ,000 , $ 150 ,000) that you have selected and paid for at the time of purchase , or that applies
to a glven msurance coverage.
Treatment means any medical , therapeutic or diagnostic measure prescribed or recommended
by a physician in any foπn including prescription medication, investigative testing, hospitaliza
tion , surgery or other prescribed or recommended treatment directly referable to the condition ,
symptom or problem
You or Your or Yourself means the eligible person(s) named in the application attached to the
forming pa此 ofthe policy, who have paid the required premiums for the covered period stated in
the application and meet all the Conditions ofthe policy.
To be eligible for coverage under this plan , tbe applicant mus t:
a. be at least 15 days old on the date of purchase; and have been discharged from hospitaJ for at
least 48 hours prior to coverage;
b. hold a Canadian work visa Qr student visa;
c. be a Canadian or landed immigrant not covered by a government pJan in Canada; or
d. be a visitor to Canada
Coverage Offered
8. Paramedical Services: When a minimum 180-day policy is purchased , up to a maximum of $500
This plan provides coverage for the reasonabJe and customa.ry cos臼 incurred by you in case of
per practitioner for the emergency services of an osteopath , physiotherapi 时 ， chiropractor, chiropodist
emergencyoccurring while in Canada Or while 00 a temporary visit to another country (other than
and/or podiatrist. provided such treatment is prescribed by a physician
?:.?ur country o r. ?rigin) pr?vided ..>:ou spend at I~ast 51% of y?ur~?ve~ed tri p"~ duration !n Canada. 9. Acupuncture Treatment: Wben a 365-day policy is purchased , up to a maximum of $500 for
~he jn~ur~r wi.1I ~a?， s，:c~h eligj~le :xpenses, less a~y ~pplicable d~ductibJe， ~P to t~e a~ount
acupuncture treatments. Treatments must b~ pre;crib~d by a Can~dian physician and performed by
~hown in~the s~hedul~ ?ffees s~t b~ t~e governm:n.t pJan i~ y?ur p~~vi~ce or territory o~n~~i~:nc~
a C~nadian licensed acupuncturist. This ben~fit does not ~over herbal ~edicines or other product~
for non -Canadian residents and only in excess of those reimbursable by any group or individual ,
that do not have a DIN ~umber.
private or public plan or contract of insurance , including any auto insurance plan
10. Treatment ofDental Accident: Emergencydental treatmentto a maximum of$3 ,000 to repair or
Subject to all terms and conditions ofthe polic弘 the following benefits are payable \0 a maximum
replace sound natural teeth or to repair dentures or other dental devices as result of an accidental
ofthe sum insured insofar as such services are medicaJJy necessary Benefit limits are per insured
person, per tnpmchidmg any extenSIons
blow to the face mu must consult a physzcmn or a dent1StImmedately fbllOWIng the truury
Treatment must take place before you return to your country of origin. An accident report is required
Deductible: For insured persons age 85 or younger, there is no deductibJe unless you selected the
from the physician or dentist for claims purposes
$50 deductibJe option. A deductibJe of $500 applies to insured persons age 86 or older. The de
ductibJe applies per insured person , per trip.
11. Emergenc~..R:elief of Dental Pain: Emergency treatment for the relief of acute pain to natural teeth ,
For expenses to be eligible , the eme;gency' treatment for a sudden or unexpected sickness or acci~xclu~i?g ~illin~ ， root ca~a.l~， ~ro~ns ， bridg.es , toot~ :~:r_ac.tio?s a~d repairs to de~tu:es or other
dental'injuryand the ;ecessary diag;osis-and treatment must occur withi~ the period of coverage
dental devices. Coverage is limited to a maximum of $500 during the coverage period
ofthis policy.
12. Flight Accident: Up to the sum insured in case of death as a result ofan injury sustained during
Eligible expenses include
the period of coverage while trave l1 ing as a fare-paying passenger on a commercial airline. Ifthe
1. Hospitalization: HospitaJ accommodations up to semi-private rooms and hospitaJ services
total c1 aims for the same accident exceed $300 ,000 , the insurer's liability for that accident is limited
and supplies necessary for emergencycare during hospitaJization.
to $300 ,000 which wi l1 be shared proportionately among all claimants involved in the same accident
2. Physician Charges: MedicaJ treatm四川 by a physician.
and who are covered under a JF Optimum Visitor policy underwritten by the insure汇
13. ~:I?~~~!~~~: ~~~?_aPE~~~~~ in_~~v:'.n..':~!~~!:.':~_g:.db~ th..':a~sista~ce c~ml_'any. (Please refer to
SEC Tl ON ':'1 Ll MIT_:\T10NS AND RESTRI<_:: T10NS # 7 - Right to Transfer.)
a. ~p t? the cost.~~ ~ on~-~~?， economy airfare to r:turn you t? your cou.~tr;: of ori!t in; or
b. the fare for additional ~irl!n~ seats to accommodate a stretcher or medical attendant , to return
you to your country of origin
14. ~reparati.on an~ Retu~n_ ofRemai~s: In _the event of ?eath , up t~ a maximum of$10 ,000 towards
t,he actl_l al cost inc~~r:d for preparat!on. o~ remains and ho~eward :r~~sy_o!t~tion ofth~ deceased
!ns~r~d p~rsor: to hi~/~er .cou_n:ry?f orig~n; or up !? a maxi~u.m of ~4，000 for cremation and/or
?uria~ at the place of death ofthe insured person. The cost ofthe casket or urn is not covered by this
benefit
15. 24-Hour Travel Assistance Services:
a. Coordination of all medical care , transportation and repatriation;
b. Telephone interpretation services in most languages;
c. Monitor progress during trea 臼η ent and recovery by managed care
16. Follow-Up Treatment: Benefits are payable up to maximum limit of $3 ,000 per policy for nonemergency medicaJ treatment, provided treatment is a direct result ofthe initial emergency medicaJ
treatment
3. Diagnostic Services: Laboratory tests and X-rays prescribed by the attending physician due
to an emergency Note: This poÍicy does not co~er'magnetic re;onance imaging (MRJ) ,
cardiac cathete~ization ， comp~teriied axial tomography (CAT) scans, sonog~a~s，
gastroscopy, enteroscopy, ultrasounds or biopsies~ u~le-ss necessary in a medical emergency
ãnd apprô~ed by the ass-istance company prior to any actions.
4. Private Duty Nursing: Expenses for the profi巳ssional services of a registered nurse (nonfamily member) for private~duty nursing ~hile hospitalized during an~acute emerge~cy
sickness or i吨j~ry， ~hen ordere~d by the~attending physician and p;e-approved by the
~~ ~
assistance co~p;ny.
,.,
5. Ambulance Services: When reasonable and medicaJJy necessar只 licen sed ground
ambulance service (also covers tax i fare in lieu of ground ambulance) to the nearest hospitaJ
6. Prescription Drugs: Up to $500 , limited to a 30-day supply per prescription , unless you are
hospitalized , drugs , serums and injectables that can only be obtained upon medical
prescription , that are prescribed by a physician and that are supplied by a licensed pharmacist
when required as a result of an emergency This benefit does not cover drugs , serums and
1时 ectables necessary for the continued stabilization of a chronic medical condition , except in
case of emergency,
7. Medical Appliances: When prescribed by a physician and approved in advance by the
assistance company, minor appliances such as casts , splints , canes , slings , trusses , braces ,
crutches and/or rental of a wheelchair,
A - The Contract
l. This contract offers coverage up to the sum insured selected
2. The insurer reserves the right to decline any application or any request for an extension of
coverage
3. Only one policy can be issued to you and all premiums paid for any additional policy will be
returned to you. When more than one policy ofthis form is issued by the insurer and is ìn
force with respect to you at the tìme of claim , only one such policy, the earliest by effective
date, wi ll appl y.
B - Coverage Begins and Ends:
1. Coverage bcgins on thc effective date of the insurance. There are waiting periods as noted in
SEC Tl ON V- Coverage , itcm 3a, 3b, 3c
2. Coverage ends on the e.λpirydate.
C - Duration of Coverage
l. The maximum period of coverage under this plan , including any extension(:吟 ， is 365 days for
persons up 10 age 85 inclusively, and 180 days for persons age 86 years old or older. No
coverage is avaì lable ìn excess of these periods either by extension , renewal or new policy for
any insured, unless pre-approved by the insurer.
2. A temporary vìsit to another country as part of your covered trip must
a. originate in Canada; and
b. not exceed 49 0/0 of your covered tr 币 's duration
Note: A temporary visit to your country of origin is not covered
3. Waiting Period - When coverage is purchased any time a白er your arrival in Canada
a. If you are age 86 or older, then in respect of any sickness, you will not be entitled to
receive reimbursement for sickness or symptoms which manifested or were contracted
or treated within 15 days following the effective date ofthis polic y.
b. If you are age 85 or under, then in respect of any sickness, you will not be enti t1 ed to
receive reimbursement for sickness or symptoms which manifested or were contracted
or treated within 48 hours following the en企ctive date of this policy
c. For all ages , then in r巳:spect of any sickness, you will not be entitled to receive
reimbursement for sickness or symptoms which manifested or were contracted or
treated within seven days following the effective date if the policy was purchased 30
days or more after arrival in Canada
d. The waiting period may be waived (upon approval from administrator compan，炒 i f this
policy
i. is purchased on or prior to the expiry date of an existing policy already issued by the
administrator company to take effect on the day following such expiry date, provided
no increase in the aggregate policy limit (Sum Insured Option) or rate schedule
change is applied for;
ii. the administrator company specificall y waives or modifies the waiting period in
wntmg; or
iii. if you have coverage with another insurer during the first part of your trip in
Canada , and you are purchasing this insurance after your arrival ìn Canada and
there will be no gap in your coverage , you may request to have the Waitìng Period
waived. You must provide proof satìsfactory to the administrator company that you
have other coverage in force prior to purchasing this policy and receive written
approva l from the administrator company
4. Stable Pre-existing Medical Condition Coverage
a. Stable pre-existing medicaJ condition(s) are eligible for coverage for insureds age 69 or
younger
b. StabJe pre-existing medicaJ condition(s) are eligible for coverage for insureds age 70 to
85 if you paid the required premium for the stable pre-e.λ isting medical condition
coverage option on the date of purchase
JFOPT 2015-01
D - Automatic Extension of Coverage
Upon notifying the administrator company or the insurer, coverage will be extended automatically
without additional premium for up to 72 hours if your stay is prolonged beyond the period for which insurance has been purchased , due to the following reasons
l. you are hospìtalized due to an emergency on the expiry date indicated on your confirmation
of insurance. 1旬 ur coverage will remain in force as long as you are hospitalized and the 72-hour
extension will commence upon release 仕om hospital;
2. a late train , boat , bus , plane , or other vehicle in which you are a passenger causes you to miss
your scheduled return to your country of origin, including by reason of inclement weather;
3. the vehicle in which you are travellìng is involved in a traffic accident or mechanical breakdown
that prevents you from returning to your country of origin;
4. you must delay your scheduled return to your country of origin because you are not deemed
medically stable to travel by the assis阳ncecompany
Note: All claims incurred after the expiry date of your insurance policy must be supported by
documented proof of the event resulting in your delayed return. This benefit does not include costs
associated with flight change
E - Changes to Coverage
1. If you decide to extcnd yourtrip and necd an extension of yourcoverage , the insurer may approve
your request subjcct to the following conditions
a. your request for an cxtcnsion must bc made directly to the administrator company prior to
the e.λ:p iry date of the existing coverage;
b. you have not required mcdical services in exccss of $500 during your period of coverage
unless pre-approvcd by the assistance company
c. your total period of coverage (in c1 uding a l1 extcnsions approved or requested) w il1 not
continue beyond the maximum number of days allowed as noted in Section V - Coverage ,
itemC # 1
d. the rcquest for the extension is received not more than 10 days prior to thc expiry date of your
coverage;
e. the rcquired premium is charged to your credit card
2. Upgrades to the sum insured arc available providcd you have not required medical services in
excess of $500 during your period of coverage. There will be a forty-eight (48) hour waiting pcriod
after the rcquest is approved by the insurer for thc upgraded sum insured to be availablc
3. Newborns are e1igible for coverage under this plan on the later of:
i. the day they bccomc an eligible chiJd as defined in Section 1I; or
ii. forty-eight (48) hours after re1ease from hospitaJ
You must add thc newborn to your application and pay the appropriate premium
Note: The minimum prcmium is $25 pcr extension. The cost of add itional days of insurance will
be ca1culated bascd on thc total trip duration , the age of the insUI 巳 d on the purchase date ofthe
extension and using the premium schedulc in effcct at the timc the extension is requested
F - Premium Payment
The required premium is due and payable at the time of application and will be determined according
to thc rate schedule then in effcc t. Prcmium rates , policy terms and conditions arc subjcct to changc
without prior noticc. A minimum prcmium of$25 applics. The prcmium is bascd on youragc as ofthe
purchase datc. A famiJy ratc is available. Family in c1 udcs thc applicant , agc 60 and undcr, thc
applican t's spouse, agc 60 and undcr, and chiJdren. The premium for family covcrage is calculated at
two timcs thc prcmium for thc cldcst adu 1t agc 60 and undcr. Ifthc premium paid is insufficient for thc
period of coverage sclcctcd , the administrator company w i1l
1. chargc and collect any underpaymcnt; or
2. shorten thc po1icy pcriod by writtcn endorscment if an underpaymcnt in prcmium cannot be
collectcd. Coveragc will be null and void if thc prcmium is not rcccived , if a chequc is not honourcd
for any rcason , if credit card chargcs are inva 1id or ifno proof of your paymcnt exists
2
For policies with coverage of $100 ,000 or over and with a duration of one year:
G - Family Coverage
Yourpolicy covers you and all famiJymembers named on the application (Please refer to the definition in SEC TlON 11) 证
1. coverage dates are the same for all 血miJy members;
2. all famiJy members live at the same address while in Canada; and
3. the premium for family coverage is paid prior to the effective date ofthe policy, as shown on
tbe application or confirmation of insurance
H - Premium Refunds
1. Jf cancellation of your policy is requested prior to the effective date of your policy, the full
premium will be refunded
2. Tftermination of your policy is requested because you must return to your country of origin
prior to your scheduled return date, a partial amount (I ess an administration fee of $40 per
insurance policy) ofthe premium paid may be refunded , provided 00 c1 aim has been incurred
at any time during your trip
3. Requests for refunds must be made in writing within 90 days of your policy expiry date to the
admÎnistrator company Ifthe administra阳 r company receives satisfactory proof (eg. airline
ticket or customs/immigration stamp) of your actual return date to your country of origin ,
your refund wi \l be calculated from that date , other、iV ise calculation ofsuch refunds will be
based on the post marked date ofyourwritten reques t. No refund will be issued ifthe amount
of premium to be reimbursed 阻 less than $10 per pol icy
1. 1f cancel1ation is requested prior to the 吃庐山时 date of your po1i町， you must provide
evidence of a Super Visa rejection letter from the government for a full premium refund. No
refund will be made ifthe primary reasons ofrejection are due to the following reasons: 1) client
did not complete the medical examination. 2) client did not complete an interview. 3) client did
not provide required documents needed for the super visa application
2. Jftermination of your po1icy is requested after the ejJective dα 阳， you must provide evidence of
a boarding pass and e-ticket from the ai r1 ine for a partial premium refund. There must be no
claims incurred at any time during your policy period. And administration fee of $40 per
insurance policy applies
3. Requests for refunds must be made in writing within 90 days of your policy expiry date to the
administrator company ffthe administrator company receives satisfactory proof (eg. bo盯ding
pass or customs/immigration stamp) of your actual return date to your country of origin , your
refund wi \l be calcu1ated from that date , otherwise calcu1ation of such refunds wi \l be based on
the post marked date ofyourwritten reques t. No refund wi l1 be issued ifthe amount of
premium to be reimbursed is 1ess than $10 per po1icy.
1 - Trip Change
No Change can be made to the pol icy after the
policy 收ctive
date
1. Pre-Approval of Treatment
The assis 归nce company must approve in advance any surgery, invasive procedure (i ncluding ,
but not lirnited to , cardiac catheteri z atio时 ， diagnostic testing , referrals to speciahsts or
treatment. lt remains your responsibility to inform yo盯 attending physician to call the
assistance company for approval , except in extrerne circumstances where such action would
delay surgery required to resolve a life threatening medical crisis
2. Notice to the assistance company
You or someone on your behalf must contact the assistance company prior to treatment when
ever possible. Failure to contact the assis臼nce company within twenty-four (24) hours of
receiving medicaJ treatment or admission to hospitaJ will limit benefits otherwise payable to
70% ofthe sum insured or $50 ,000 , whichever is 1ess
3. Limitation of Benefits
Once you are deemed medically stabJe to return to your country oforigin (with or without a
medical escort) in the opinion of the assis归nce company or by virtue of discharge from
hospital, your emergency is considered to have ended , where upon any further consultat旧n，
treatment, recurrence or complication related to the emergency, you will no longer be eligible
for coverage under this polic y.
4. Benefits Limited to Reasonable and Customary Cost
1f you pay eligible expenses directly to a hea1th service provider, these services will be
reimbursed to you on the basis ofthe reasonabJe and customary costs that would have been
paid direct1y to the provider by the assistance company. Medical charges you pay may be
higher than this amount , therefore you will be responsible for any difference between the
amount you paid and the reasonabJe and customary costs reimbursed by the insurer.
5. Benefits Li mited to lncurred Expenses
Ifany ofthe benefits are duplicated under a similar benefit or under another insurance coverage
in this policy or another policy issued by the insure.ιthe maximum you are entitled to is the
largest amount speci 日 ed under any one benefit or insurance coverage. The total amount paid to
you from all sources cannot exceed the actual expenses you incur
6. Availability and Quality of Care
Thc insurer (including any of its subsidiarics , affiliatcs , affiliatcd brokcrs and agcnts) sha\l not
bc hcld rcsponsib1c for thc avai1abi1ity or quality of any medicaJ treatment (including thc rcsults
thereoηor transportation , or your failure to obtain medicaJ treatment while on a covered trip
7. Right to Transfer
The assistance company, in consultation with the attending physician , reserves the right to
transfer you to another hospitaJ or medical facility capable of providing the necessary medical
services , or to return you to Canada or your country of origin. Refusal to do so will absolve the
insurer of further liability
The insurer will not reimburse you for insured services or pay Flight Accident claims arising
from
1. any sickness, disease or injurywhich had manifested itselfin the 120-day period immediately
preceding the ef论 ctive date ofthis policy. Unexpected emergency sickness, disease or injury
shall be considered to have manifested itselfwhen
a. medical care , advice , investigation or treatment has been received; or
b. drugs or medicines have been taken or prescribed to treat the sickness, disease or injury;
or
c. you have experienced symptoms which would cause a reasonably prudent person to seek
diagnosis , care or treatmen t.
Under Exclusion # 1, whenever you purchase another JF Optimum Visitor policy because you
are staying in Canada longer, each new policy will have a new ef论 ctive date and you will not
be covered under the new policy for any sickness, disease or injury which had manifested itself
in the 120-day period immediate1y preceding that new effective date
2. intentional self-injury, suicide or attempted suicide while sane or insaoe
3. any loss , sickness, injury or death related to the misuse , abuse , overdose , or chemical
dependence 00 medication , drugs , alcohol , or other intoxicant , whether sane or insane
4. any sickness or symptoms which manifested or were contracted or received treatment within
a. 15 days following the effective date ifyou are age 86 or older; or
b. the first 48 hours following the ef论ctive date if you are age 85 or younger;
if you purchased this policy after your arrival in Canada; or
c. the first 7 days following the ef论ctive date for all ages;
if you purchased this policy 30 days or more after your arrival in Canada
5. hospita1ization or services rendered in connection with general health examinations for
check-up purposes , treatment of ao ongoing condition , regular care of a chronic condition ,
home health care , investigative testing , rehabilitation or ongoing care or treatment in
connection with drugs , alcohol or any other substance abuse
6. expenses incurred as a result of symptomatic or asymptomatic HTV infection or H1V-related
conditions and AJDS (acquired immune deficiency syndrome) , including any associated
diagnostic tests or charges
7. an act ofwaror an act ofterrorism when you are outside ofCanada and covered under this
m surance
8. any treatment , hospitaJization or surgery (including elective , non-elective , personal comfort ,
dental or cosmetic) which is not considered to be an emergency, even if it is recommended by
a physician
9. elective , non-emergenc.只 medical or health-care treatment or insured services which you knew
would be required when you applied for this policy
10. a continuation or treatment or service first recommended or prescribed by a physician or
health-care practitioner before the ef论 ctive date ofthis policy or where such insured services
were first initiated prior to the effective date ofthis policy or during the Waiting Period
11. the purchase or rep1acement cost (prescribed or not) , loss or damage to hearing devices; eye
glasses; suoglasses; contact lenses; or prosthetic teeth , limbs or devices and prescription
resulting there from
12. yourobtaining medical or health-care assessment or any form ofreport or document for the
purposes of supporting an application to obtain immigrant status in Canada
13. travel and accommodation expenses incurred for the purposes of receiving insured services
14. a disorder, disease , condition or symptom that is emotional , psychological or mental in nature
unless you are hospitaJized
15. preventive medicine or vaccines or refill ofprescription medication
16. any medical condition you suffer or contract in a specific country, region or city for which
Foreign Affairs and Jnternational Trade Canada has issued a formal Travel Warning before
your effective date, advising against al1 or oon-essential travel to that specific country, region or
city. 1n this exclusion , the term medical condition is limited to the reason for which the formal
Travel Warning was issued and includes complications arising from such medical conditions
17. a criminal act or an attempt to commit a criminal act
18. any loss incurred as a result of pregnancy, abortion , miscarriage , childbirth or complications
thereo f.
19. expenses resulting from participation in professional sports; any speed contest; SCUBA diving
(unless PADJ , ACUC or SSJ certified); extreme spor阻 ， including , but not limited to
parachuting; mountaineering; skydiving; rodeo; hang gliding; bungee cord jumping; acrobatic
flying; stunt flying or flight accident unless riding as passenger on a commercial1y licensed
airline , except while being transported under the terms ofthe Repatriation benefit
20. cataract surgery or services provided by an optometrist
2 1. fillings , root canals , crowns , bridges , tooth extractions and repairs to dentures or other dental
devices
22. costs incurred due to sickness or injury resulting from a motor vehicle accident where you are
entitled to receive benefits pursuant to any policy or legislative plan of motor vehicle insurance ,
except when such benefits are exhausted
The assistance company's Emergency Assistance staff are available to answers your questions 24
hours a day, 7 days a week
1. Travel Assistance Centre
No matter where you are , professîonal assîstance personnel are ready to take your cal1
Please consult your insurance card for emergency assistance numbers
2. Benefit lnformation
Explanation ofyourpolicy is available to you and to the medical providers who are treating
you
3. Case Management
Our experienced and professional team , available 24 hours a day, will monitor the servÎces
gîven in the event of an emergency.
4. Interpretation Service
We can connect you to a foreign language interpreter when required for emergency services
in foreign countries.
5. Direct Billing
Whenever possible , we will instruct the hospitaJ or clinic to bill the insurer directly
6. Claim lnformation
We wiU answer any questions you have about the eligibility of your claim , our standard
verification procedures and the way that your policy benefits are administered
JFOPT 2015-01
3
Claim forms are available from the administrator company or from the assistance company
online atww 、N. travel insu rance.ca/clai m
Please Contact
OnTime Care Worldwide [nc
15 Wertheim Court, Suite 501
Richmond Hill , Ontario , Canada L4B 3H7
Toll free Canada/USA: 1-866-209-5804
Collect worldwide: 905-707-9555
You must substantiate yourclaim by providing all documents listed below. (The insureι adminis
trator company or assistance companyare not responsible for charges levied in relation to any
such documents.)
1. A completed Claim Form (provided by the administra阳 r company or aSSJstance company
upon notification of c1 aim)
2. Original itemized bills from Ii censed medical provider(s) stating the patient's name , diagnosis ,
date and type of treatment, and the name , address and telephone number ofthe provider, as
well as the original transaction documents proving that payment was made to the provider
3. Original prescription drug receip阳台om the pharmaci 目 ， physician or hospitaJ indicating the
name ofthe prescribing physician , prescription number, name ofpreparation , date , quantity
and total cost
Note: Tf you refuse or fail to sign any form or refuse to provide any information pertinent to your
claim , it may affect the processing of your c1 aim
Please refer to SEC Tl ON X[ - STATUTORY CON DlTlONS #5
Payment of Benefits
AII payments are payable to you or on your behal f. Any c1 aims paid to you will be payable in Cana
dian funds. No sum payable shall bear interest
For eme引gencies that required hospitaJization or surgery, telephone the Travel Assistance Centre at
tbe numbers listed below.
You or someone acting on your behalf must call the Travel Assistance Centre immediately. Their
operations are backed by a team of travel assistance pro也 s s ionals- medical professionals who work
closely with the doctor looking after you and , if necessary, your family doctor, to help ensure that
you receive the medical care you need
1. Subrogation
lf you suffer a loss covered under this policy, the assistance company is granted the right
from you to take action to enforce all your rights , powers , privileges and remedies upon
making payment or accepting the claim to the extent ofthe incurred losses , against any
person , legal person or entity which caused such loss. Additionally, ifNo Fault benefits or
other collateral sources of payment of expenses are available to you , regardless of 也 ult， the
assÎstance company is granted the right to make a demand for, and recover those benefits. lf
the assÎstance company institutes an action , the assÎstance company may do so at its own
expense , in your name , and you wiU attend at the place of loss to assist in the action. lf you
institute a demand or action for a covered loss you shall immediately notify the assÎs阳nce
company so that it may safeguard its rights. You shall take no action after a loss that wi 1I
impair the rights of the assistance company set forth in this paragraph and shall do such
tbings as are necessary to secure the its rights
2. Other Insurance
This insurance 1S a second payer plan. For any loss or damage insured by, or for any c1 aim
payable under any other liability, group or individual basic or extended health insurance plan ,
or contracts including any private or provincial or territorial auto insurance plan providing
hospitaJ, medical , or therapeutic coverage , or any other insurance in force concurrently here
with , amounts payable hereunder are limited to those covered benefits incurred outside your
country oforigin that are in excess ofthe amounts for which you are insured under such other
coverage. A lI coordination with employee-related plans fo l1 ows Canadian Li 也 and Health
Insurance Association Inc. guidelines. Tn no case wi l1 the assistance company seek to recover
against employment-related plans ifthe li 也time maximum for a l1 in-country and out-oι
country benefits is $50 ,000 or less. [f your lifetime maximum is greater than $50 ,000 , the
assistance company wi l1 coordinate benefits only above this amount
3. Misrepresentation and Non-disclosure
The entire coverage under this policy shall be void ifthe insurerdetermines , whetber be且ore
or after loss , that you bave concealed , misrepresented or failed to disclose any material fact
or circumstance concerning your policy or your interest therein, or if you refuse to disclose
information or permit the use of such information , pertaining to any ofthe Însured persons
under this contract of insurance
4. Arbitration
Notwithstanding any clause in the present policy, the parties bereto undertake to submit to an
arbitration procedure , to tbe exclusion of the courts , any present or future dispute relating to a
claim. The arbitration pro四 edings shall be governed by arbitration laws in force in the province
or territory where this policy was issued. The parties agree that any action wiU be referred to
arbitration
5. Applicable Law
This contract ofinsurance is governed by the laws ofthe province or territory where this policy
was issued. Any legal proceeding by you, your heirs or assigns shall be brought in the courts of
the province or territory 飞IVhere this policy 飞;vas issued
6. Safeguarding Your Privacy
Tbe admÎnÎstrator corr>'pany places great importance 00 the protection of your privacy. The
admÎnistrator company and the assistance company collect your personal information when you
apply for this insurance and in the event of a claim , to provide you with insurance services and
to analyze your claim. This information remains confidential , as is required under applicable
federal and provincial laws. ln the event of a claim , tbe assÎstance company may collect your
personal health information held by a third party. This information may be released to
employees of the adminÎstrator company and the insurer for claims analysis and to better serve
you.ln no case will the Însurerrelease this information to any person or organi zation that is not
clearly entitled to it without first seeking your consent
7. Limitation of Actions
An action , arbitration or similar proceeding against the insurer for the recovery of a c1 aim under
this contract shall not be commenced rnore than one year after the date the insurance money
became payable or would have become payable ifit had been a valid claim. [fthis limitation is
invalidly shorter than the limitation prescribed by the laws ofthe province or territory in which
this policy was issued an action , arbitration or similar proceeding against the insurer shall not
be commenced later than the shortest limitation period prescribed by the laws ofthat province
or te盯 itory ofresidence. The limitation periods stated in this section apply to a l1 plans and
benefits ofthis policy and to all endorsements thereo f.
1. The Contract
The application , this policy, any docurnent attached to this policy when issued , and any
amendments to the contract agreed upon in writing after the policy is issued , constitute the
entire contract , and 00 agent has authority to change the contract or waive any of its
6. Failure to Give Notice or Proof
Failure to give notice of claim or furnish proof of claim within the time prescribed by this
statutory condition does oot invalidate the claim if the notice or proof is given or furnished as
soon as reasonably possible , and in no event later than one year from the date of the accÎdent or
the date a claim arises under the contract on account of sic.kn ess if it is shown that it was oot
reasonably possible to give notice or furnish proof within the time so prescribed
7. The Assistance Company or the Administrator Company to Furnish Forms for Proof of
Claim
The assistance company or the admínistrator company sha l1 furnish forms for proof of claim
within 15 days after receiving notice of c1 aim , but where the c1 aimant has not received the forms
within that time the c1 aimant may submit his or her proof of claim in the form of a written
statement ofthe cause or nature ofthe accident or síckness giving rise to the c1 aim and ofthe
extent of the loss
8. Rights of Examination - As a condition precedent to recovery of insurance money under this
contract
a. the c1 aimant shall afford to the ins盯er an opportunity to examine the insured person
when and so often as it reasonably requires wbile the claim hereunder is pending; and
b. in tbe case ofdeath ofthe Însured, the insurermay require an autopsy subject to any law
of the applicable jurisdiction relating to autopsies
proVl 日 ons
2. Waíver
The insurer shall be deemed not to have waived any condition ofthis contract , either in whole
or in part , unless the waiver is clea rly expressed in writing and signed by the insure瓦
3. Copy of Application
Tbe insurer shall , upon request , furnisb to the Însured or to a claimant under the contract a
copy of the application
4. Material Facts
No statement made by you at the time of application for this contract shall be used in defense
of a claim under or to avoid this contract unless it is contained in application or any other
written statements or answers furnished as evidence of insurabilit y.
5. Notice and Proof of Claim - You or a beneficiary entitled to make a claim , or the agent of
any of you , shall
a. give written notice of claim to the assÎstance company by delivery thereof or by sending
it by registered mail to the assistance company no later than 30 days from the date the
claim arises under the contract 00 account of an accident or sickness;
b. within 90 days from the date a claim arises under the contract on account of an accident
or sickness， 且lTnish to the assÎstance company such proof of claim as is reasonably
possible in the circumstances oftbe happening ofthe accidentor the commencement
of the sÎckness , and the loss occasioned thereby, the right of claimant to receive
payrnent , bis or her age , and the age of the beneficiary if relevant; and
c. if so required by the assÎstance company or the Însurer, furnish a satisfactory certificate
as to tbe cause or nature ofthe accident or sickness for which claim may be made under
the contract
Insurance is administered by JF Insurance Agency Group Inc.
Travel assistance and c1 aims services are provided by OnTime Care Worldwide Inc. and SelectCare Worldwide Inc
Insurance is underwritten by CUMIS General Insurance Company, a member ofThe Co-operators group of companies
JFOPT 2015-01
4